#caseous necrosis

[jeanusmle]

[lethalbotox]

Cheese-Like Appearance

Pathologists love using food to describe diseases, and the most commonly used food-derived description you'll hear in medical school is 'cheese-like appearance'. The first thing that usually comes to mind when you hear the term 'cheese-like appearance' is tuberculosis.

                         The yellow cheese-like material in the picture above is found in cases of TB. Think of feta or cottage cheese.

However, many diseases cause a cheese-like appearance, because a cheese-like appearance is how caseous necrosis looks like. Caseous necrosis is a type of necrosis that occurs due to granulomatous reactions. For example in TB the body tries to wall off the bacteria from spreading by surrounding it with inflammatory cells, this walling off by using inflammatory cells is known as a granuloma. So what happens is the middle part of the granuloma starts to die resulting in the infamous 'cheese-like appearance'. Syphilis is an example of a granulomatous reaction hence caseous necrosis will result. Something you should keep in mind is that a specific amount of necrosis is needed for the caseous necrosis to appear, so the size of the granuloma is directly proportional with the amount of 'cheese-like appearance' you'll see. This is important because many people define sarcoidosis as non-caseating granulomas. That description isn't a rule, it can be non-caseating if the granulomas are small, which is sometimes the case, and it can be caseating and cheesy if the granulomas are large.

I apologize if all you think of the next time you eat cheese is tuberculosis.